Quick Reference Guide - creativepharmacist.com...EnrollHub Quick Reference Guide 09.19.2016 ©2015 CAQH. All rights reserved Quick Reference Guide

EnrollHub Quick Reference Guide 09.19.2016

©2015 CAQH. All rights reserved

Quick Reference Guide



Contents Purpose ......................................................................................................................................................... 3

Registration and Activation ......................................................................................................................... 4

Determine Number of Enrollments ............................................................................................................. 8

Enrollment Application .............................................................................................................................. 16

Provider Details ........................................................................................................................................... 16

Bank Information ........................................................................................................................................ 19

EFT and ERA Enrollment.............................................................................................................................. 21

Status Review ............................................................................................................................................. 27



Purpose

The EnrollHub Quick Reference Guide is designed to aid new users in completing the CAQH EnrollHub application.



Registration and Activation

CAQH EnrollHub Provider website: https://solutions.caqh.org/bpas

Step 1: Click the Register Now button to begin the registration process.

Step 2: Complete the User Information fields.

Note: The Email account will be used to validate the user as part of the activation process in Step 8.

https://solutions.caqh.org/bpas



Step 3: Complete the Company Information section.

Step 4: Create a Username and Password that will be used to access the account. If the password is forgotten, security questions will be used to recover the account.



Step 5: Review and agree to the Terms of Service.

Step 6: Confirm the account details and click Submit.



Step 7: Click OK to confirm the registration.

Step 8: Complete the activation email.

NOTE: If you do not receive the activation email, please contact the Help Desk (844-815-9763 Option 1) for assistance.



Determine Number of Enrollments

When completing the application, a user will determine the number of enrollments they to create when completing the application and enrolling with payers. An Enrollment is defined by a new record created in the EnrollHub website under a User’s profile.

In Exhibit A, when a user clicks the Add New Provider button, this action will create a new enrollment for the user to complete. This process is documented in the Enrollment Application section of the document.

Exhibit A

Users should enter enrollments based on how their organization is reimbursed for claims. Below are scenario’s that can impact the number of enrollments that will need to be created by a user.

− Using multiple TIN’s − Using multiple bank accounts − Billing at the facility NPI level − Billing at a P\provider level

The following diagrams illustrate how the enrollments should be submitted.



Scenario 1 – Single Organization TIN with the Same Bank

Location 1TIN 123456NPI 111111



Bank ABC

Health Payer A

Claims

TIN Level Enrollment

Payments made on a single check

Enrollment 1

In this scenario, claims are submitted using the same TIN and single bank combination. Users with this payment model should submit a single enrollment for their organization. Under the claim bulk preference select the TIN level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application).

Example: One (1) enrollment is needed for the organization.



Scenario 2 – Single Organization TIN with Different Facility NPI’s and Banks




Bank ABC

Health Payer A

Claims

NPI Level Enrollment


Bank DEF

Claims

Bank GHI

Claims

Health Payer A



Health Payer A



Enrollment 1 Enrollment 2 Enrollment 3

In this scenario, claims are submitted with the same TIN however, have different Facility NPI’s and banks. A user with this payment model will need to submit single enrollments for each location for their organization. Under the claim bulk preference select the NPI level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application).

Example: Three (3) enrollments are needed for the organization.



Scenario 3 – Multiple Organization TIN’s with the Same Bank




Claims


Bank ABC

Claims Claims

Health Payer A





In this example, claims are submitted with the different Facility TIN’s, NPI’s and each location is reimbursed to the same bank account. A user with this payment model will need to submit separate enrollments for each location for their organization. Under the claim bulk preference select TIN level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application). This details all




Scenario 4 – Multiple Organization TIN’s Using Different Banks




Bank ABC

Health Payer A

Claims



Bank DEF

Claims

Bank GHI

Claims

Health Payer A



Health Payer A




In this scenario, claims are submitted with a different Facility TIN and NPI for reimbursement to different bank accounts. A user with this payment model will need to submit enrollments for each location of their organization. Under the claim bulk preference select NPI level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application)




Scenario 5 – Single Organization TIN Using the Same Bank

Bank ABC

Health Payer A

Claims



Enrollment 1

TIN 12456NPI 111111

TIN 123456NPI 222222

TIN 123456NPI 333333

TIN 123456NPI 444444

TIN 123456NPI 555555

In this scenario, all claims are submitted with the same Facility TIN and different provider NPI for reimbursement. A user with this payment model only needs to submit a single enrollment for their organization. Under the claim bulk preference select TIN level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application).





Bank ABC

Health Payer A

Claims



Claims Claims




Provider 1TIN 123456NPI 111111



In this scenario, claims are submitted with the same Facility TIN and different provider NPI’s for reimbursement. A user with this payment model will need to submit individual enrollments by provider for their organization. Under the claim bulk preference select NPI level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application).






Bank ABC

Health Payer A

ClaimsNPI Level Enrollment


Enrollment 1

Provider 1TIN 123456NPI 111111Provider 2

TIN 123456NPI 222222Provider 3

TIN 123456NPI 333333

In this scenario, claims are submitted with a different Facility TIN and NPI for reimbursement to different bank accounts. A user with this payment model will need to submit enrollments for each location of their organization. Under the claim bulk preference select NPI level aggregation for account structure and payment processing. (See Step 6 of Section 3 of the application).

NOTE: In this variation the user can create a single enrollment and itemize the individual providers under the Associated NPI list in the Step 5 Section 3 of the application.




Enrollment Application

Provider Details Step 1: Upon login, the user will be presented with a “Welcome” pop-up screen that includes a tour of the product. Click Close Tour to continue with the application process.

Step 2: Click Add New Provider



Step 3: Insert the provider details and Save.

x Provider Information - This section will consist of the Group/Practice information. Information should match your current billing information that is submitted on claims today.

o Provider Name/DBA Name - Users will need to enter the Provider Entity or Practice Name under the Provider Name field that is associated to the TIN. If a DBA “Doing Business as Name” is used, that will need to be included in the DBA field.



o Address Information - In this section, enter the billing address for the Provider/Group including the provider’s Street, City, State/Province and ZIP Code/Postal code.

o Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) - In this section, enter the TIN for the provider practice.

o National Provider Identifier - In this field, please enter the entity’s billing NPI. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers known as National Provider Identifiers (NPI) (www.cms.gov). The NPI requested in this section is the Type 2 NPI, which is for the NPI assigned to the provider entity as opposed to the individual practitioner. TIN and NPI should match to your billing information. NPI is typically the Type 2 number for the facility.

x Provider Contact Name – This section is for who will be the main contact for the location/facility that can help with answering EFT related questions.

x Provider Agent Name – If an organization does use a 3rd party billing service, the user can include the additional contact for that organization who is providing the service.



Bank Information Step 4: Click Add Financial Institution to add bank account

Step 5: Insert the Financial Institution Details information



Step 6: Complete the Account Number Linkage to Provider Identifier and Enrollment Submission sections to establish how the claims will be bulked and coordinating banking details.



EFT and ERA Enrollment Step 7: Select Add New Enrollment to submit an EFT enrollment

Step 8: Select the bank account that will be included in the enrollment.



Step 9: Select the payer(s) to enroll with EFT, and select Next button.

NOTE: Select payers you are currently submitting claims to today.

Step 10: Confirm the payers and click Next.



Step 11: Review the Authorization agreement, check I Agree and select Ok

Step 12: Confirmation display page of the EFT enrollment. User has the option to enroll in ERA if available.



Step 13: Select the payer(s) to enroll in ERA and select Next.

Step 14: Select the Clearing House from the drop down, enter the Trading Partner ID for the Clearing House (Optional) then click Save and Continue.



Step 15: Review the information that is being submitted for ERA enrollments and select Next.

Step 16: Review the Payment Signature, check the I Agree box and select Ok.



Step 17: Confirmation display page for the ERA enrollment(s). Select Done to navigate from the ERA section.

The application is now complete and will begin the review process to validation the bank document, bank account and authorization of the enrollment. Users can continue to add new payers to their EFT and ERA enrollment sections during the review process. There is not a need for Users to wait until the review has been completed to add additional enrollments.



Status Review

Once an enrollment has been submitted, the provider application will undergo a review. The validation status can be tracked in the following fields:

x Provider Details – CAQH will engage in a series of outbound phone call to confirm authorization of the enrollment with the location.

x Financial Institution - The banking information will be reviewed for accuracy and Prenote tested for set-up.

Provider Details

Provider Authorization Status Status Definition Not Verified There is no data verification status until all data

entry has been completed and an enrollment has been submitted to a payer.

Pending Authorization − A provider record has been used in an enrollment.

− The provider’s bank record is undergoing a document verification process.

Verification Requested − The provider has submitted an enrollment to a payer.

− The bank document verification process is complete and verified.

− CAQH is verifying user authorization. Pended Provider authorization is in progress. Verified − The provider’s Name and has been

verified.



− The provider’s office has been contacted.

− User’s authorization to submit payment information has been confirmed.

Declined − CAQH could not verify that the registered user is authorized to submit EFT enrollments on behalf of the provider.

Financial Institution Information

Bank Verification Status Status Definition Pending The bank record is in this status when new or

edited bank record is submitted with an enrollment and is ready for document processing.

Document Processing − The provider has entered all required bank information.

− The document is undergoing further verification.

Document Verified − CAQH has verified that the Provider Name or DBA was entered.

− The provider information matches the name that appears on the uploaded bank document.

Document Failed − The provider uploaded a document that did not match the information entered in the Provider Name, Routing Number and Account Number fields.

− There was an issue with the quality of the document.

− A new or edited document will need to be submitted that matches the information entered.



Prenote Pending − The provider’s banking information has been verified

− The prenote process has begun. Verified − The provider’s bank account

information has been verified. − The banking information has passed

the prenote test. Prenote Failed − The test transaction using the bank

account and routing number entered during enrollment has failed.

− The banking information will need to be updated and resubmitted.

Status of a providers record with a payer is displayed under the Status section of the enrollment.

Enrollment Status Definition Enrollment Request Pending The provider record is undergoing the CAQH

validation Process. Enrollment Requested − Enrollment has completed the validation

process. − The information is being delivered to the

payer for review. Received



− This status displays as soon as the payer marks the enrollment as Received.

− The payers mark enrollments as received to let the provider know that they have the request.

− The payers will notify providers directly and outside of EnrollHub when enrollment processing is complete on their end.

Declined

− The payer has declined the enrollment request. (To find out reasons for a decline, view the alert in the message center.)

− If a payer declines the enrollment, edit and resubmit the documentation to the payer.

Documents

Quick Reference Guide - creativepharmacist.com...EnrollHub Quick Reference Guide 09.19.2016 ©2015 CAQH. All rights reserved Quick Reference Guide